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CDI Action to Secure Insurance Coverage for Autism

CDI is committed to increased access for transformative behavioral therapy for children with autism. The Department's purpose and goal is to ensure that insurance companies are in full compliance with California's mental health parity law, which requires that all medically necessary treatment be provided to children with autism, and with other provisions of the insurance code.

CDI provided strong support for SB 946, which ensures coverage of behavioral health treatment, including Applied Behavior Analysis (ABA) therapy, for autism. In addition, the department continues to monitor new legislation with the potential to impact autism and related disorders. In support of the law, the CDI has initiated enforcement actions against a number of insurers to obtain coverage of ABA therapy. Also included on this page are links to other general resources for autism, guides to obtaining insurance coverage, and links to other departments where helpful resources concerning autism can be found.

Please note that the links below are for informational purposes only and CDI is not responsible for the content on these websites.

Autism Emergency Regulations
Senate Bill 946
Other Relevant Legislation
Litigation
Governmental/Scientific Support for ABA Therapy
Enforcement Actions
Independent Medical Review
Help Getting Insurance Coverage for Autism
General Resources
Other Governmental Agencies
Related Organizations


The CDI has new emergency regulations interpreting the Mental Health Parity Act and SB 946. The regulations aim to eliminate delays and denials of coverage for autism treatment, were approved by the Office of Administrative Law, and are effective on March 11, 2013. The text of the regulations, as well as a Consumer Alert, can be found below.

Autism Emergency Regulations

Text of the Regulations

Consumer Alert: CDI Emergency Regulations Prohibit Denial and Delay of Autism Treatment


Information on Senate Bill 946 and the role the CDI has played in supporting this new law can be found below, along with current relevant legislation and litigation associated with, or having the potential to impact, autism.

Senate Bill 946: Behavioral Health Treatment

CDI Consumer Alert: Know Your Rights to Autism Treatment

Video of Senate Select Committee Hearing
The video can be found under the heading: "Health Insurance Coverage for Autism Spectrum Disorders (ASD) - 07/13/2011"

Transcript of Commissioner Dave Jones' Testimony

Photos and Video of September 26th Rally

CDI Position on the Scope of the Mental Health Parity Act; Statement of Support for SB 946

SB 946: Chaptered Law

Other Relevant Legislation

Current legislation from the Senate Select Committee on Autism and Related Disorders

SB 951: Health care coverage: essential health benefits

AB 1453: Essential health benefits

Litigation

Harlick v. Blue Shield: Amicus Curiae submitted by CDI

Burton v. Blue Shield (This decision is being appealed)

Shahzeb v. Regional Center of the East Bay

Rea v. Blue Shield of California

Elliot v. San Andreas Regional Center

Governmental/Scientific Support for ABA Therapy

ABA Therapy for Autism is Nationally Accepted and Approved

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In terms of ensuring coverage of ABA therapy after the passage of SB 946, the CDI has engaged in the following enforcement actions with insurers to require coverage of behavioral therapy for autism. Also included is a Notice the CDI sent to all admitted insurers in the state of California, reminding them that the CDI is committed to enforcing the provisions of the Insurance Code governing Independent Medical Review of disputed health care.

Enforcement Actions: Insurers to Provide Coverage for Behavioral Health Treatment

Blue Shield: Order to Show Cause, Order, Settlement

Health Net: Order to Show Cause, Stipulation and Waiver

CIGNA: Order to Show Cause, Stipulation and Waiver

UnitedHealthcare: Order to Show Cause, Stipulation and Waiver

Anthem: Order to Show Cause, Stipulation and Waiver

Related Press Release 

Notice to Insurers of Enforcement of Independent Medical Review Statutes

Independent Medical Review

General information concerning the IMR process, including a Consumer Alert: "Challenging Denials of Health Claims and Requesting an Independent Review"

Statistics for current and prior year decisions

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For help obtaining insurance coverage for autism and other disorders, we hope you'll find the following information useful. Additionally, some general resources have been listed as well as a number of related organizations to visit for further information.

Help Getting Insurance Coverage for Autism

FAQs: Obtaining Coverage of Behavioral Health Treatment through Your Insurer

Autism Health Insurance Project

AHIP is a 501 (c3) Public Benefit Corporation that works with families, providers and other relevant parties and helps them secure health insurance and other coverage for autism related interventions. AHIP provides information for both state regulated and self-insured health plans.

General Resources

Autism Speaks: Resource Guide for CA

SAMHSA: Children with Special Needs; Resources

Special Needs Network: Tools for Transformation; A parent and professionals conference

The Autism Society: Resources for family members of individuals with autism

Other Governmental Agencies

California Department of Developmental Services
The DDS provides services and support to individuals with developmental disabilities.

California Department of Managed Health Care
The DMHC regulates HMOs and other Managed Health Care Plans.

California Department of Mental Health
The DMH works in partnerships to ensure the availability of services for people with mental illnesses through advocacy, education, and outreach.

Senate Select Committee on Autism and Related Disorders
The Senate Autism Committee promotes policies and legislation to assist individuals with Autism Spectrum Disorders.

Substance Abuse and Mental Health Services Association
SAMHSA seeks to connect people to substance abuse and mental health services and to translate research in these areas more effectively and rapidly into the general healthcare system.

Related Organizations

Autism Speaks
Autism Speaks is an autism science and advocacy organization dedicated to funding research into the causes, prevention, treatments and a cure for autism.

California Autism Foundation
California Autism Foundation (CAF) offers state funded programs for children and adults with autism and other developmental disabilities.

California Coalition for Mental Health
The CCMH is an advocacy alliance that monitors the implementation of the Mental Health Services Act (MHSA), and offers trainings and other information regarding the MHSA.

California Healthcare Foundation
CHCF is a nonprofit grantmaking philanthropy that supports ideas and innovations that improve quality, increase efficiency, and the lower the costs of care.

Disability Rights California
Disability Rights California is a non-profit disability rights organization, working to advance human and legal rights of Californians with disabilities.

Health Access
Health Access is a statewide health care consumer advocacy coalition which undertakes community organizing and education, applied research, and policy analysis, and advocates for reform to benefit health care consumers, both insured and uninsured.

The Autism Society
The primary mission of The Autism Society is to raise and allocate funds to address the many unanswered questions about autism.

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